Amid the growing burden of Alzheimer’s in the U.S., researchers aim to better understand the relationship between the disease and the places people live.
Experts estimate that nearly 40 percent of the more than eight million Americans living with Alzheimer’s and related dementias will be Latino or Black by 2030. Where people live matters, researchers say, and delving into the disparities of risk factors and prevalence of dementia across neighborhoods and counties — especially for communities of color — is key to identifying gaps in research, public health policies and services.
According to a 2020 report by UsAgainstAlzheimer’s and the Urban Institute, deep social, geographic, and health inequities exist between counties where people of color have the highest rates of Alzheimer’s and related dementias, and counties where those rates are the lowest. Studying these inequities may lead to clues about how to decrease Alzheimer’s risk, and help address the disease’s disproportionate burden on people of color.
Stipica Mudrazija, the lead author of the report and senior research associate at the Urban Institute said while researchers in the field have gained a more comprehensive understanding of the medical science behind Alzheimer’s and related dementias, much less is known about the socioeconomic factors and geographic disparities linked to the disease.
“Research on Alzheimer’s and related dementias has indeed made great strides in increasing understanding of the causes and origins of the disease, including genetic factors in recent years,” Mudrazija said during a virtual conference. “Yet, there has been significantly less research on the impact of place and the social determinants of health that may shape the risk of Alzheimer’s disease and related dementias.”
To address this gap in research, the authors of the report analyzed 2016 Medicare data and identified the top 25 counties in the U.S. with the highest and lowest prevalence of Alzheimer’s and related dementias among Black, Latino and non-Latino white populations. Then, they compared the counties’ demographics, health and socioeconomic profiles to identify trends and risk factors. The team found that, in the counties where Blacks and Latinos had the highest rates of dementia, there was a striking pattern: These counties also had lower levels of education, lower household incomes, residents had less access to parks and recreational facilities to exercise, and residents self-reported higher rates of physical and mental distress.
The Relationship Between Alzheimer’s and Learning
One factor that seems to be universally important, Mudrazija said, was the difference in education.
“We see across all racial and ethnic groups that counties with the lowest prevalence [of dementia] tend to have a much higher level of education than the counties with highest prevalence,” he said, “with the difference being somewhat higher for Latinos and non-Latino Blacks than non-Latino whites.”
In the counties where Blacks and Latinos had the
highest rates of dementia, there was a striking pattern:
These counties also had lower levels of education, lower
household incomes, residents had less access to parks and
recreational facilities to exercise, and residents self-reported
higher rates of physical and mental distress.
The report revealed that only 16 percent of adults have a bachelor’s degree in counties with the highest prevalence among Blacks, the researchers wrote, compared to twice that in counties at the other end of the spectrum. Only 19 percent of adults have a bachelor’s degree in counties with the highest prevalence among Latinos, compared to 27 percent of adults in counties with the lowest prevalence.
According to William Vega, an author of the report and the former executive director of Roybal Institute on Aging at University of Southern California, education can build people’s cognitive reserves, helping their brains develop capacity to resist dementia and manage its progression. Education is also linked to people’s socioeconomic status and health behaviors such as diet, which are in turn associated with Alzheimer’s and related dementias.
Alzheimer’s and Quality of Life
Jason Resendez, an author of the study and head of the LatinosAgainstAlzheimer’s coalition, who also spoke at the conference, added that the report highlights the disproportionate burden people of color are bearing in the fight against Alzheimer’s.
“This report finds that deep social inequities exist in counties most impacted by Alzheimer’s disease among Latinos and Blacks,” he said, and that, in turn, “demonstrates the impact of place in determining our conditions and ability to live a healthy lifestyle.”
Experts stress that living a healthy lifestyle is critical to managing risk of developing Alzheimer’s and related dementias. A recent report by the Lancet Commission on dementia prevention, intervention, and care, shows that physical inactivity, depression and social isolation in old age and nine other factors across the lifespan may delay or prevent 40 percent of dementia cases worldwide.
“Many of these risk factors are directly shaped by place, including education, social isolation, physical inactivity, and air pollution,” researchers of the report by UsAgainstAlzheimer’s and Urban Institute wrote. “These same factors impact communities of color and low resourced communities disproportionately, meaning that Alzheimer’s risk-reduction opportunities could be even greater within those populations if these risk factors and social determinants of health are addressed equitably and urgently.”
To address these disparities, UsAgainstAlzheimer’s recently announced the creation of the Center for Brain Health Equity, collaborating with nursing professionals and community-based organizations to develop public health strategies for communities of color, improving data collection and diversifying the research pipeline.
“We know the social determinants of health can act as barriers to health care access and treatment,” said Resendez, who is also the executive director of the Center for Brain Health Equity. “That’s why documenting trends in the social determinants in these highly impacted counties is important as health systems and governments develop programs to support communities that are hard hit by Alzheimer’s.”
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